Provider Demographics
NPI:1265981625
Name:BORDER PAIN INSTITUTE, PA
Entity type:Organization
Organization Name:BORDER PAIN INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:O
Authorized Official - Last Name:VIESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-857-4130
Mailing Address - Street 1:1810 MURCHISON DR STE 50
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2927
Mailing Address - Country:US
Mailing Address - Phone:915-857-5130
Mailing Address - Fax:915-857-4135
Practice Address - Street 1:1000 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4008
Practice Address - Country:US
Practice Address - Phone:915-857-4130
Practice Address - Fax:915-857-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TXL5602208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty